Provider Demographics
NPI:1083269351
Name:NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC
Other - Org Name:NH NHRMC SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RETAIL & SPECIALTY RX
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGERTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-667-5147
Mailing Address - Street 1:2250 SHIPYARD BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8070
Mailing Address - Country:US
Mailing Address - Phone:910-667-5149
Mailing Address - Fax:910-662-7777
Practice Address - Street 1:2250 SHIPYARD BLVD STE 12
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8070
Practice Address - Country:US
Practice Address - Phone:910-662-7780
Practice Address - Fax:910-662-7777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-05
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083269351Medicaid